OCD

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Transcript of OCD

Chau TranJessica TrinhTiffany Wang Obsessive Compulsive Disorder WHAT IS OBSESSIVE COMPULSIVE DISORDER? CAUSES OF OCD OVERVIEW Obsessions are defined as:Intrusive and irrational thoughts, impulses, or images that are experienced at some time during the disturbance"my hands must be contaminated"Compulsions are defined as:Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession in order to reduce stress or prevent a dreaded situation TYPES OF OCD BehavioralDue to learned behavioral-related habits Conditioned response to reduce anxietyGeneticFraternal twins: 40-50%Identical: 80%InfectionPANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections)NeurobiologicalAbnormalities in the brain BackgroundTypesDiagnosisCausesNeurobiologyCortico-Basal Ganglia ConnectionsSerotonin DysfunctionTreatmentSSRI'sBehavioral TherapyOverview DSM IV DIRECT & INDIRECTPATHWAYS 3 MAJOR AFFECTEDAREAS: OCD PATHWAY Orbitofrontal cortex - cognitive processing of decision makingCaudate nucleus - regulates "automatic" behaviors (such as brushing teeth and walking)Thalamus - screens caudate information and signals back to the frontal cortex Information from the frontal cortex flows into the indirect & direct pathways of the basal ganglia:Direct Pathway – excitatoryFacilitates thalamic stimulation of the cortexIndirect Pathway – inhibitoryInhibits the thalamas, allowing the cortex to respond to novel stimuliIn OCD there is an imbalanced stimulation of the direct pathway and indirect pathway which contributes to the compulsive and repetitive behaviors. Overstimulation of the caudate nucleus increases activity of the thalamus which sends a flood of signals back to the frontal cortex to cause repetitive behavior DYSREGULATION OFSEROTONIN Serotonin is a neurotransmitter that's involved in regulating anxiety, mood, sleepIn OCD, some receptors are thought to block serotonin from entering the cellIn one study, lower levels of serotonin are associated with OCD involving disinhibited approach behaviors (recurrent violent thoughts), and higher than normal levels are associated with OCD involving avoidance behaviors (washing and checking) Treatment by SSRI's Most studies show that patients with OCD have lower levels of serotoninStudies show that reduced serotonin transporters availability in the mibrain may reflect the low serotonin levelsSSRI - selective serotonin reuptake inhibitorBlock reuptake to make serotonin more available in the synapse for other neurons EXPOSURE AND RITUAL PREVENTION (ERP) Components:Exposure in vivo : patient confronts cues that trigger obsessive thoughtsImaginal exposure: patient imagines distressing thoughts/situationsRitual Prevention: patient is instructed to abstain from performing the behavior produced by the obsessionProcessing: discuss the patient’s experience Checking rituals - patients feel like they didn't perform a task correctly so they repeatedly perform it over and over until it's "just right"Ex. checking to see if the door is closed rightCleaning - patients avoid contact with contaminated objectsEx. washing the dishes over and overObsessive thoughts - patients have recurrent and unwanted thoughts that are not expressed as behavioral ritualsEx. thinking that you murdered someoneOther types - ordering rituals, obsessional slowness where patients are "stuck" performing a routine task Jenike et al. (1986) Jenike et al. (1986)Walitza et al. (2011) orbitofrontal cortex caudate nucleus EARLY BEHAVIORAL THERAPY Systematic DesensitizationGradual exposure to anxiety-provoking stimuli while the patient is in a relaxed stateAversion Therapy“Rubber-band snapping technique”The patient is instructed to snap the rubber band on their wrist every time they have an obsessive thought“Thought-stopping”The therapist or patient shouts “stop” immediately after an obsessive thoughtThese two methods were not effective in reducing OCD symptoms. DIAGNOSIS Criteria: Individual must have obsessions or compulsions that are present for most days for at least 2 successive weeksSymptoms are not a result of outside influencesIndividual must realize that obsessions or compulsions are excessive and unreasonableIndividual tries to resist them but at least one obsession or compulsion is unsuccessfully resistedObsessions and compulsions significantly interfere with daily activitiesThey are unpleasantly repetitive OVERVIEW: OCD is classified as illogical obsessions that lead to uncontrollable repetitive behaviorsOCD can be caused by hyperactivity of the caudate nucleus, which thereby causes an imbalance of the direct and indirect pathwaysDeficiency in serotonin contributes to the anxious nature of OCD, which can be treated with antidepressants such as SSRI’s or psychotherapy References http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181954/